scholarly journals Overview on Temporary Abdominal Closure Techniques: A Review

2021 ◽  
pp. 68-74
Author(s):  
Hashem Bark Awadh Abood ◽  
Sadeel Fahad Daghistani ◽  
Nouf Hashem Koshak ◽  
Yazid Ali Alghamdi ◽  
Sahad sami Ghamri ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Abdominal Hypertension ◽  
Fluid Regulation ◽  
Abdominal Compartment ◽  
Emergency Abdominal Surgery ◽  
The Ideal

Open abdomen (OA) is becoming more common, primarily to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) following emergency abdominal surgery. The purpose of temporary abdominal closure (TAC) techniques is no longer just abdomen coverage; fluid regulation and early fascial closure are now important considerations. TAC techniques for leaving the abdomen open are numerous. The ideal one should be simple to apply and remove, allow for quick access to a surgical second opinion, drain secretions, ease primary closure with acceptable morbidity and mortality, allow for easy nursing, and, finally, be readily available and inexpensive. Over the years, several TAC methods have been proposed. In this review, we overview different techniques for temporary abdominal closure and its advantages and disadvantages.

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

2021 ◽  
Author(s):  
Vincenzo Pappalardo ◽  
Stefano Rausei ◽  
Vincenzo Ardita ◽  
Luigi Boni ◽  
Gianlorenzo Dionigi
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Secondary Peritonitis ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Primary Fascial Closure

AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

Advanced Age May Limit the Survival Benefit of Open Abdominal Decompression

2011 ◽  
Vol 77 (7) ◽  
pp. 856-861 ◽  
Author(s):  
Michael L. Cheatham ◽  
Karen Safcsak ◽  
Creighton Fiscina ◽  
Christopher Ducoin ◽  
Howard G. Smith ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Patient Survival ◽  
Survival Rates ◽  
Age Groups ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Abdominal Hypertension ◽  
Abdominal Decompression ◽  
Abdominal Compartment ◽  
Eighth Decade

Open abdominal decompression (OAD) and temporary abdominal closure (TAC) are widely performed for the treatment of intra-abdominal hypertension and/or abdominal compartment syndrome. During 2005 to 2009, 405 consecutive patients required OAD/TAC (trauma 68%, surgery 24%, medicine 5%, burn 3%). Overall patient survival to hospital discharge was 65 per cent regardless of age and was significantly decreased among patients older than 70 years of age ( P < 0.0001). Survival by decade of life exceeded 50 per cent through the eighth decade but decreased to 19 per cent for the ninth decade (older than 80 years of age). Survival varied significantly by service (trauma 72%, surgical 56%, burns 55%, medical 33%) ( P < 0.0001). Successful definitive fascial closure rates (range, 75 to 100%) were equivalent among all age groups ( P = 0.78). Survival after OAD/TAC varies by decade of life and mechanism of injury/illness. Age alone should not negate the use of OAD/TAC. Reasonable survival rates may be expected for patients younger than 80 years of age.

scholarly journals Open abdomen treatment with negative pressure wound therapy at department for abdominal surgery, UCC Maribor: Our experiences and results

2016 ◽  
Vol 63 (1) ◽  
pp. 121-123
Author(s):  
Bojan Krebs
Keyword(s):  
Abdominal Surgery ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Cavity ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Pressure System ◽  
Abdominal Closure ◽  
Primary Surgery ◽  
Better Than

Introduction: With the development of modern surgery we often come to situation where, after the procedure, closing of abdomen is not feasable. There are many techniques of temporary abdominal closure but best results today are achieved with negative pressure system. Despite widespread use, there is still a lot of confusion regarding the indications, the application of the technique and complications. Objective: The aim of our study was to explain the system with negative pressure and show our experience and results in the treatment of patients with it. Methods: We retrospectively analyzed the data of all patients from 2011 to 2014 which were treated with negative pressure. We were interested in following data: the date of the primary surgery, diagnosis, date and indication for use of the system with negative pressure, the number of system changes, type of final closure of the abdominal cavity and the date of discharge or death. Results: Between 2011 and 2014 we treated 52 patients, 32 men and 20 women with a system with negative pressure. The average age of the patients was 67 years (25 - 85 years). 25 patients were operated on electively and due to complications we used the system for negative pressure. In 27 patients we used negative pressure system after the primary emergency procedure. Mortality was 50 %. Conclusion: The treatment of the open abdomen with negative pressure is an essential part of modern abdominal surgery. Survival after treatment with negative pressure is better than with other techniques of temporary abdominal closure. Man must take in consideration problems with fascial closure and big postoperative hernias wich demand further operations.

Complications and Mortality Associated with Temporary Abdominal Closure Techniques: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 83 (2) ◽  
pp. 191-216 ◽  
Author(s):  
Adam Cristaudo ◽  
Scott Jennings ◽  
Ronny Gunnarsson ◽  
Alan Decosta
Keyword(s):  
Systematic Review ◽  
Open Abdomen ◽  
Meta Analysis ◽  
Final Analysis ◽  
Fascial Closure ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Central Register

Temporary abdominal closure (TAC) techniques are routinely used in the open abdomen. Ideally, they should prevent evisceration, aid in removal of unwanted fluid from the peritoneal cavity, facilitate in achieving safe definitive fascial closure, as well as prevent the development of intra-abdominal complications. TAC techniques used in the open abdomen were compared with negative pressure wound therapy (NPWT) to identify which was superior. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines involving Medline, Excerpta Medica, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Clinicaltrials.gov. All studies describing TAC technique use in the open abdomen were eligible for inclusion. Data were analyzed per TAC technique in the form of a meta-analysis. A total of 225 articles were included in the final analysis. A meta-analysis involving only randomized controlled trials showed that NPWT with continuous fascial closure was superior to NPWT alone for definitive fascial closure [mean difference (MD): 35% ± 23%; P = 0.0044]. A subsequent meta-analysis involving all included studies confirmed its superiority across outcomes for definitive fascial closure (MD: 19% ± 3%; P < 0.0001), perioperative (MD: -4.0% ± 2.4%; P = 0.0013) and in-hospital (MD: -5.0% ± 2.9%; P = 0.0013) mortality, entero-atmospheric fistula (MD: 22.0% ± 1.8%; P = 0.0041), ventral hernia (MD: -4.0% ± 2.4%; P = 0.0010), and intra-abdominal abscess (MD: -3.1% ± 2.1%; P = 0.0044). Therefore, it was concluded that NPWT with continuous fascial traction is superior to NPWT alone.

Challenges in the Management of the Open Abdomen

ICU Director ◽  
2012 ◽  
Vol 4 (1) ◽  
pp. 33-39 ◽  
Author(s):  
David J. Worhunsky ◽  
Gregory Magee ◽  
David A. Spain
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Original Description ◽  
Fascial Closure ◽  
Critically Ill Patient ◽  
Temporary Abdominal Closure ◽  
Recurrence Rates ◽  
Abdominal Closure ◽  
Intra Abdominal Infection ◽  
Temporary Closure

First described more than 60 years ago, the open abdomen has now become a relatively common entity in surgical ICUs. Although the indications for an open abdomen have evolved since the original description of the damage control laparotomy, the goal remains to provide an unstable or critically ill patient time to correct their physiologic derangements. Temporary abdominal closure is thus used as a bridge to definitive repair and closure. Unfortunately, the open abdomen is associated with significant morbidity and mortality, and recent studies have suggested an overuse of the technique. Once the decision is made to proceed with an open abdomen, multiple options exist for temporary abdominal closure. The hope is to obtain definitive closure shortly thereafter in an attempt to reduce potential complications including intra-abdominal infection or enteroatmospheric fistula. Options for temporary closure range from the Bogotá bag to vacuum-assisted techniques; a combined technique of sequential fascial closure with vacuum assistance has recently been shown to result in 100% fascial approximation. In situations where fascial closure is unattainable, temporary coverage with a skin graft may be employed, followed by late abdominal closure via complex abdominal herniorrhaphy. Even using advanced methods such as component separation or a “pork sandwich” technique, the complication and recurrence rates remain high. A careful understanding of the indications, optimal management, and potential complications of the open abdomen is necessary to limit its overuse and ultimately reduce some of the challenges associated with it.

scholarly journals Standard Urine Collection Bag as an Improvised Bogotá Bag as a Temporary Abdominal Closure Method in an Open Abdomen in Preventing Abdominal Compartment Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ahmed Shabhay ◽  
Zarina Shabhay ◽  
Kondo Chilonga ◽  
David Msuya ◽  
Theresia Mwakyembe ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Wall ◽  
Abdominal Compartment Syndrome ◽  
Open Abdomen ◽  
Anterior Abdominal Wall ◽  
Temporary Abdominal Closure ◽  
Urine Collection ◽  
Abdominal Closure ◽  
Closure Method ◽  
Abdominal Compartment

Primary abdominal wall closure post laparotomy is not always possible. Certain surgical pathologies such as degloving anterior abdominal wall trauma injuries and peritoneal visceral volume and cavity disproportion render it nearly impossible for the attending surgeon to close the abdomen in the first initial laparotomy. In such surgical clinical scenarios leaving the abdomen open might be lifesaving. Forceful closure might lead to abdominal compartment syndrome and impair respiratory status of the patient. Open abdomen closure techniques have evolved over time from protection of abdominal viscera to complex fascia retraction prevention techniques. Silo bags, i.e., (Bogotá Bags), are relatively cheap, available materials used as a temporary abdominal closure method in limited resources settings. Despite its limitations of not preventing fascia retraction and draining of peritoneal fluid, it protects the abdominal viscera. We report a case of a 29-year-old male who developed incisional anterior abdominal wall wound dehiscence. He was scheduled for emergency explorative laparotomy. Intraoperatively, multiple attempts to reduce grossly dilated edematous bowels into the peritoneal cavity and fascia approximation into the midline were not possible. A urinary collection bag was sutured on the skin edges as a temporary abdominal closure method in prevention of abdominal compartment syndrome. He fared well postoperatively and eventually underwent abdominal incisional wound closure. In emergency abdominal surgeries done in limited surgical material resource settings were primary abdominal closure is not possible at initial laparotomy, sterile urine collection bags as alternatives to the standard Bogota bags as temporary abdominal closure materials can be safely used. These are relatively easily available and can be safely used until definite surgical intervention is achieved with relatively fewer complications.

Open Abdomen Treatment for Septic Patients with Gastrointestinal Fistula: From Fistula Control to Definitive Closure

2014 ◽  
Vol 80 (4) ◽  
pp. 339-347 ◽  
Author(s):  
Jianan Ren ◽  
Yujie Yuan ◽  
Yunzhao Zhao ◽  
Guosheng Gu ◽  
Gefei Wang ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Abdominal Wall Reconstruction ◽  
Fascial Closure ◽  
Wound Complications ◽  
Temporary Abdominal Closure ◽  
Gastrointestinal Fistula ◽  
Operative Strategy ◽  
Abdominal Infection ◽  
Abdominal Closure ◽  
Intra Abdominal Infection

The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.

scholarly journals Open Abdomen Management and Candida Infections: A Very Likely Link

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Savino Occhionorelli ◽  
Monica Zese ◽  
Rosario Cultrera ◽  
Domenico Lacavalla ◽  
Marco Albanese ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Open Abdomen ◽  
Case Series ◽  
Abdominal Sepsis ◽  
Temporary Abdominal Closure ◽  
Retrospective Case ◽  
Abdominal Closure ◽  
Closure Duration ◽  
Abdominal Hypertension ◽  
Significant Difference

Objective. Laparostomy can be applied in trauma, abdominal sepsis, intra-abdominal hypertension, or compartment syndrome. Systemic infections, especially if complicated by Candida, are associated with a high risk of mortality. Methods. This is a single-centre retrospective case series of 47 cases admitted to our Department, which required laparostomy procedure; we analyzed the type of surgery, temporary abdominal closure, duration of open abdomen, complications, SOFA score, mortality with Candida infections, and empirical or targeted antifungal therapy. Results. We found that patients with Candida infection were related with a statistically significant difference (p<0.05) with a complication after OA closure, total complications, time elapsed after OA application, time spent on the first surgical OA application, type of temporary abdominal closure that is used, and duration of the open abdomen. The use of empirical and targeted antifungal therapy is related to the duration of open abdomen too. Conclusions. Management of the OA is often burdened by sepsis or septic shock, especially when complicated by Candida infection. Candida score is a validated tool to identify patients who can be treated empirically, but every situation must be considered on an individual basis.

Compartment Syndrome

2017 ◽  
Author(s):  
Basem Attum ◽  
William Obremskey ◽  
Bradley Dennis ◽  
Richard Miller
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Clinical Signs ◽  
Skin Closure ◽  
Temporary Abdominal Closure ◽  
Diagnosis And Management ◽  
Abdominal Closure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

Compartment syndrome is a process that can develop anywhere skeletal muscle or abdominal organs are encased by a rigid fascial layer. This review describes the different aspects of these conditions, including the epidemiology, pathophysiology, diagnosis, and management of compartment syndrome in the extremities and abdomen. Diagnosis is expanded on further to describe clinical signs in the alert patient and the different methods of compartment measurement in the obtunded patient or when a physical examination is inconclusive. The anatomy of the leg, thigh, buttocks, forearm, and arm is described, along with surgical techniques for fasciotomy. Postoperative care, the different methods of wound management and skin closure, and diagnostic criteria for the diagnosis and management of abdominal compartment syndrome are discussed. Treatment of abdominal compartment syndrome with decompressive laparotomy and temporary abdominal closure is also described. Figures depict various fasciotomies and an algorithmic approach to management. Tables show the contents and function of the compartments of the leg and forearm. Key words: abdominal compartment syndrome, compartment syndrome, decompressive laparotomy, extremity, fasciotomy, intra-abdominal hypertension, intra-abdominal pressure, temporary abdominal closure, tibia fracture

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